Interhemispheric Modulation of Dual-Mode, Noninvasive Brain Stimulation on Motor Function

OBJECTIVE: To investigate the effects of simultaneous, bihemispheric, dual-mode stimulation using repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on motor functions and cortical excitability in healthy individuals. METHODS: Twenty-five healthy, right-handed volunteers (10 men, 15 women; mean age, 25.5 years) were enrolled. All participants received four randomly arranged, dual-mode, simultaneous stimulations under the following conditions: condition 1, high-frequency rTMS over the right primary motor cortex (M1) and sham tDCS over the left M1; condition 2, high-frequency rTMS over the right M1 and anodal tDCS over the left M1; condition 3, high-frequency rTMS over the right M1 and cathodal tDCS over the left M1; and condition 4, sham rTMS and sham tDCS. The cortical excitability of the right M1 and motor functions of the left hand were assessed before and after each simulation. RESULTS: Motor evoked potential (MEP) amplitudes after stimulation were significantly higher than before stimulation, under the conditions 1 and 2. The MEP amplitude in condition 2 was higher than both conditions 3 and 4, while the MEP amplitude in condition 1 was higher than condition 4. The results of the Purdue Pegboard test and the box and block test showed significant improvement in conditions 1 and 2 after stimulation. CONCLUSION: Simultaneous stimulation by anodal tDCS over the left M1 with high-frequency rTMS over the right M1 could produce interhemispheric modulation and homeostatic plasticity, which resulted in modulation of cortical excitability and motor functions.

Correction: Relationship Between Gross Motor Function and Daily Functional Skill in Children With Cerebral Palsy

We found that a number of tables were inadvertently omitted.

Relationship Between Gross Motor Function and Daily Functional Skill in Children With Cerebral Palsy

OBJECTIVE: To investigate the relationship between gross motor function and daily functional skill in children with cerebral palsy (CP) and to explore how this relationship is moderated by the Gross Motor Function Classification System, Bimanual Fine Motor Function (BFMF), neuromotor types, and limb distribution of CP. METHODS: A cross-sectional survey of 112 children with CP (range, 4 years to 7 years and 7 months) was performed. Gross motor function was assessed with the Gross Motor Function Measure-66 (GMFM-66) and functional skill was assessed with the Pediatric Evaluation of Disability Inventory-Functional Skills Scale (PEDI-FSS). RESULTS: GMFM-66 scores explained 49.7%, 67.4%, and 26.1% of variance in the PEDI-FSS scores in the self-care, mobility, and social function domains, respectively. Significant moderation by the distribution of palsy and BFMF classification levels II, III, and IV was found in the relationship between GMFM-66 and PEDI-FSS self-care. Further significant moderation by the distribution of palsy was also observable in the relationship between GMFM-66 and PEDI-FSS mobility. CONCLUSION: These findings suggest that limb distribution and hand function must be considered when evaluating gross motor function and functional skills in children with CP, especially in unilateral CP.

Clinical, Electrophysiological Findings in Adult Patients with Non-traumatic Plexopathies

OBJECTIVE: To ascertain the etiology of non-traumatic plexopathy and clarify the clinical, electrophysiological characteristics according to its etiology. METHOD: We performed a retrospective analysis of 63 non-traumatic plexopathy patients that had been diagnosed by nerve conduction studies (NCS) and needle electromyography (EMG). Clinical, electrophysiological, imaging findings were obtained from medical records. RESULTS: We identified 36 cases with brachial plexopathy (BP) and 27 cases with lumbosacral plexopathy (LSP). The causes of plexopathy were neoplastic (36.1%), thoracic outlet syndrome (TOS) (25.0%), radiation induced (16.7%), neuralgic amyotrophy (8.3%), perioperative (5.6%), unknown (8.3%) in BP, while neoplastic (59.3%), radiation induced (22.2%), neuralgic amyotrophy (7.4%), psoas muscle abscess (3.7%), and unknown (7.4%) in LSP. In neoplastic plexopathy, pain presented as the first symptom in most patients (82.8%), with the lower trunk of the brachial plexus predominantly involved. In radiation induced plexopathy (RIP), pain was a common initial symptom, but the proportion was smaller (50%), and predominant involvements of bilateral lumbosacral plexus and whole trunk of brachial or lumbosacral plexus were characteristic. Myokymic discharges were noted in 41.7% patients with RIP. Abnormal NCS finding in the medial antebrachial cutaneous nerve was the most sensitive to diagnose TOS. Neuralgic amyotrophy of the brachial plexus showed upper trunk involvement in all cases. CONCLUSION: By integrating anatomic, pathophysiologic knowledge with detailed clinical assessment and the results of ancillary studies, physicians can make an accurate diagnosis and prognosis.

Changes of the Thyroid Function in Continuous Ambulatory Peritoneal Dialysis Patients / 대한신장학회잡지

BACKGROUND: In peritoneal dialysis patients, altered thyroid function was reported but the frequncy and pathophysiology were not well understood. The object of this study is to evaluate the effect of continuous ambulatory peritoneal dialysis (CAPD) on thyroid function by observing the frequency of primary thyroid dysfunction and the sequential change of thyroid function after CAPD. METHODS: In a cross-sectional study, thyroid function test (TFT) was done for 192 CAPD patients between Jan. 2001 and Jan. 2002. For another 38 CAPD patients, we observed the sequential change of thyroid function by performing TFT before and 6, 12, 24 months after CAPD. Thyroid hormones were quantitated after 200 mL sample of 24-hour dialysate effluent was lyophilized. TFTs were interpreted as subclinical hypothyroidism (sbhypo) when TSH is over 5 uIu/mL, mild hypothyroidism (mhypo) when TSH is between 5 and 10 uIu/mL with decreased fT4, and overt hypothyroidism (ohypo) when TSH level is over 10 uIu/mL with decreased fT4. RESULTS: Frequencies of normal thyroid function, sbhypo, mhypo and ohypo were 81.2%, 11%, 5.2%, and 2.6% respectively. Serum levels of TSH before and 6, 12, 24 months after CAPD were 2.6 +/- 0.1, 3.8 +/- 0.3, 4.2 +/- 0.5, 4.1 +/- 0.5 uIu/mL respectively and the frequencies of thyroid dysfunction including subclinical hypothyroidism were 6.4, 23.6, 26.3, 28.8% respectively, which showed the increasing tendency. Peritoneal loss of TSH was 11, 067 +/- 1, 776 uIu/day, and that of TT4 was 11.68 +/- 2.7 microgram/day. These were approximately 7%, and 10% of daily production rate. CONCLUSION: TSH increased after start of CAPD and thyroid dysfunction including subclinical hypothyoidism was observed in significant proportion of CAPD patients. Thyroid hormones were eliminated by peritoneal dialysis. It can be suggested that CAPD affects thyroid function. Clinical significance of the above observation needs further well-controlled study.

Expression of Nephrin in Puromycin Aminonucleoside Nephrosis in Rat / 대한신장학회잡지

BACKGROUND: Nephrin, a recently identified protein, could be a slit diaphragm component and it has been suggested to play a crucial role in maintaining the glomerular filtration barrier. It has been reported that mutations in the nephrin gene lead to congenital nephrosis. However, the expression of nephrin in acquired glomerular disease has not yet been fully clarified. We induced nephrotic-range proteinuria in experimental animal and performed morphologic analysis with immunoelectron microscopy. This study was designed to examine the expression and distribution of nephrin in acquired glomerular disease and to suggest a role of nephrin in pathogenesis of proteinuria. METHODS: Twenty-three rats were divided into 3 experimental groups and control(n=6). 17 rats of experimental groups had intravenous injection of puromycin aminonucleoside(PAN) singly, and were sacrificed at 1 week(n=5), 2 weeks(n=6) and 3 weeks(n= 6) later. The expression of nephrin was observed by immunoelectron microscopy employing the polyclonal antibody against nephrin and gold particle. For quantifications, the gold particles were counted from photographs. RESULTS: The average length of foot process in 1 week group(2,307+/-524 nm) was far greater than that of control(317+/-45 nm). The average number of total gold particles per unit length(10,000 nm) of the GBM was reduced at 1 week(4.4+/-1.3), compared with control(12.1+/-3.9). Also, the average number of junctional gold particles at 1 week(1.7+/-0.5) was decreased compared with control(6.7+/-2.2). No difference was observed in the number of junctional gold particles per slit diaphragm among groups. But, there were significant differences in the distribution of gold particles among groups. Gold particles were seen more frequently at apical plasma membrane and cytoplasm in 1 week group, whereas those were observed prominently at junctions in control. CONCLUSION: These data show that the expression of nephrin was decreased with effacement of foot process in PAN induced nephrosis rat. However, nephrin was preserved at not-damaged slit diaphragm. And the distribution of nephrin was changed in PAN nephrosis. Further studies for nephrin production and redistribution should be needed to understand pathogenesis of nephrotic syndrome.